I see no ships – ethical blindness in mandated vaccination of care home and NHS staff

By Fr Giles Pinnock.

As of November 11th 2021, vaccination of care home staff in England against COVID-19 became mandatory. Responses to the Government’s own consultation did not support it, and the negative impact on the care of residents, and the inevitable upstream impact on discharges from hospitals has barely registered in the media, which seem to have forgotten that their job, if nothing else, is to hold Government to account, not cheer it on from the sidelines. What is most shockingly absent though is genuine ethical debate, short of some very basic populist appeals to utilitarian ‘greatest good of the greatest number’ arguments. Like Admiral Nelson, bioethics seems to have chosen to see no ships.

A similar mandate is due to be implemented for NHS staff on April 1st 2022. Some 200,000 NHS staff are not vaccinated, and even the Government’s own figures suggest that the majority of them will remain unvaccinated. Again, responses to the Government’s own consultation did not support a mandate. Again, the potential impact on patient care of losing so many staff has barely registered. The House of Lord’s Secondary Legislation Committee has stated that the Government’s case is too weak to justify a mandate. Although welcome, that statement is no more than utilitarian, and smacked of the Westminster bubble marking its own homework.

Have we forgotten that vaccination is a medical treatment before it is subject to political policy? Anyone – including a health or care worker – is, at the point of vaccination, principally a patient. Imposition of a medical treatment consented to under coercion is an assault on the bodily autonomy of that patient, and on the ethical integrity of the clinician performing the procedure. To be threatened with losing your job and livelihood if you withhold consent is certainly coercion.

Article 6 of the UNESCO Universal Declaration on Bioethics and Human Rights states that all medical interventions are subject to prior, free and informed consent that may be withdrawn at any time and for any reason without disadvantage or prejudice.’ ‘Without disadvantage or prejudice’ clearly bars threat of loss of livelihood for withholding consent to the medical procedure of vaccination.

Article 7 of the UN International Covenant on Civil and Political Rights states that ‘no one shall be subjected without his free consent to medical or scientific experimentation,’ echoing the Nuremburg Protocol that arose from the war crimes of Nazi medical practitioners . Have we forgotten that the mRNA vaccines currently on offer remain in their trial phase – despite emergency use authorisations – until 2023, and so are experimental medicinal products at least until then?

The Declaration of Geneva binds physicians not to use medical knowledge to violate human rights and civil liberties. This surely obliges physicians to protect the human right to bodily integrity and autonomy, and the civil liberty not to consent to medical treatment.

UN conventions and the like do not have the force of law per se, but they have been woven into national laws and international treatises the explicit intention of which is to exclude the possibility of a return to the abuse of medicine as seen under the totalitarian regimes of the early twentieth century.

Conscientious objection to vaccination was recognised in English law in the 1898 Vaccination Act, compulsion to vaccinate against smallpox having been acknowledged as ineffective and damaging take up of vaccination against smallpox. This was its first appearance in any law and set the precedent for the legal recognition of the right to conscientious objection in the 1916 Military Service Act and the 1967 Abortion Act. The deprivation of the right to conscientious objection to vaccination is contrary to that important legal precedent.

Section 45E of the UK Public Health (Control of Disease) Act 1984 states that medical treatment cannot be compelled, and explicitly includes vaccination as a medical treatment. No-jab-no-job is certainly compulsion.

The Public Health England Green Book: Immunisation Against Infectious Disease, states that ‘for consent to immunisation to the [sic] valid, it must be given freely, voluntarily and without coercion.’ Consent extracted under threat of loss of employment and livelihood is not given ‘voluntarily and without coercion’.

The argument against this mandate from law and principle seems overwhelming, and yet ethicists have been near silent, and that is before considering efficacy, safety, proportionality, necessity, or natural immunity. It is fundamentally wrong to reward the commitment of NHS staff by coercing them into relinquishing their ethical, moral, and legal right to withhold consent to medical treatment.

The Government’s actions in the mandatory vaccination of care home staff, and the proposed mandatory vaccination of NHS staff, are unlawful, unethical, driven by political will and are not justified by scientific or medical facts. Care home and NHS staff who have served throughout the pandemic in service of their patients deserve better, as does ethical discourse, the practice of medicine, and the underlying relationship between every citizen and the State.

Name: Fr Giles Pinnock
Affiliation: Lead Chaplain, and member of the Clinical Ethics Committee, Imperial College Healthcare NHS Trust
Competing interests: None declared

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